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Health Plan Law and Compliance Institute 2022

Schedule

This program will be formatted as a traditional one and a half days in-person program - we are excited for attendees to connect and network in person. The program will begin on Monday, May 9 at 12:00 noon and end on Tuesday, May 10 at 5:00 pm.

AHLA is committed to providing a safe and healthy environment for program participants and staff. AHLA has adopted preventative measures to reduce the potential spread of the COVID-19 virus, including requiring proof of vaccination, and is following guidance provided by the US Centers for Disease Control and local authorities. Attendees are also expected to do their part and abide by AHLA’s Duty of Care.
 


Faculty Information

 


Schedule with Room Assignments

 


Monday, May 9, 2022

12:00-5:00 pm

Registration and Check-In
Come to AHLA Registration area to print out your badge. We'll need your proof of vaccine or a negative PCR test on the Clear Health App and Badge QR code that is emailed prior to the program for check-in.

 
1:00-2:15 pm
Welcome and Introduction
Cindy Reisz, AHLA President
Ankur Goel, Program Planning Committee

1.  What’s Happening in Health Care–Update on Federal and State Policy
Sabrina Corlette, Marc Reece, Hemi Tewarson

  • Federal legislative update and what we expect for the remainder of 2022
  • Regulatory activity under the Biden Administration
  • 2022 state health policy trends 
  • Future of health care reform: What comes next
 
2:30-3:30 pm

2. Disruption and Innovation: The Forces Changing Health Care Delivery and Payment
Luke Boyett, Gary Davis

  • Understanding the past and present with respect to disruption in managed care; what worked and what failed
  • Current trends in the disruptor market relating to managed care
  • “Mini” case studies of current disruption and disruptors and how they make affect the future of managed care
 
3:45-5:00 pm

3.  The Future is Now: Managed Care Enforcement Trends and Risk Areas
John Kelly, Brian Martens, Megan Tinker

This presentation will provide in-house counsel, compliance officers, and health care attorneys with an overview of the constantly evolving world of managed care and the risk areas being identified. This includes topics such as Medicare Advantage, the risk adjustment reimbursement process, key False Claims Act investigations and settlements, Part D oversight, and compliance dangers in federal and state level managed care programs. Members of the audience will hear directly from HHS-OIG about its oversight tools and developing areas of compliance risk seen through cases around the country. We will dig deep into the current enforcement theories and HHS-OIG Reports to educate the audience about how best to mitigate risk.

  • Enforcement trends involving managed care at the federal and state levels including Medicare Advantage, Medicaid and Part D
  • Key risk areas for plans, MSOs, and providers
  • Suggestions on how to manage risk from a compliance perspective
  • Focus areas and recent report takeaways from HHS-OIG
 
5:00-6:00 pm
Networking Reception, sponsored by BRG
This event is included in the program registration. Attendees and faculty are welcome.
 


Tuesday, May 10, 2022

7:00 am-5:00 pm

Registration and Check-In
Come to AHLA Registration area to print out your badge. We'll need your proof of vaccine or a negative PCR test on the Clear Health App and Badge QR code that is emailed prior to the program for check-in.

 
7:00-8:00 am

Continental Breakfast, sponsored by BRG
This event is included in the program registration fee. Attendees and faculty are welcome.

 
8:00-9:00 am

4. Drug Pricing: Legislative and Regulatory Developments​
(not repeated)

Margaux J. Hall
Sonja Nesbit

The past few years have featured a flurry of legislative action, agency rulemaking and executive orders targeting the pricing of pharmaceutical and biologic products, with various legal proposals and potentially significant implications for health plans. This presentation takes stock of legislative and regulatory drug pricing developments–what’s happened, what’s been delayed, and what’s likely to happen–both in 2022, and during the remainder of President Biden’s first term. Specifically, the presentation will address:

  • Potential drug pricing legislation, including in the wake of the midterm elections
  • Administrative priorities and areas of actual or likely regulatory change
  • Potential legal and policy implications
 

5. Transforming the Patient Experience: The Continued Evolution and Integration of Clinical Care and Retail Settings​
Melissa Hulke
Jeff Wurzburg

  • The state and federal legal considerations as managed care entities continue to partner with retail health care settings
  • The compliance challenges and best practices for managed care entities seeking further integration with retail health
  • How the COVID-19 pandemic has further aligned managed care and retail health considerations with consumer expectations
  • Case study of how the CVS/Aetna integration of clinical care and retail settings improves access and care coordination while lowering the cost of care
 

6. The Process of Parity: Mental Health Parity and Addiction Act (MHPAEA) Compliance and Enforcement Considerations for the Health Plan
Christina Anderson
Noreen Vergara

The requirements around the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) continue to evolve, and the law continues to gain national attention. Because of its vast reaching scope, MHPAEA is a law that every health plan lawyer should be familiar with. This presentation will offer:

  • The MHPAEA requirements and treatment limitations
  • Recent developments including the Consolidated Appropriations Act of 2021 and the 2022 MHPAEA Report to Congress
  • What may be on the horizon to strengthen MHPAEA‘s regulations and enforcement
 
9:15-10:15 am

7. Managed Care Audits
(not repeated)

Annie Hsu Shieh
Andrew Wachler

  • Emerging trends and hot topics in managed care audits
  • Insights from both the payor and provider perspective
  • What happens when the auditor becomes the audited
  • The provider response: Strategic considerations and arguments on appeal
  • Best practices and lessons learned from real-life case studies
 

8. State PBM Laws – When Are They Preempted?
Kristyn Bunce DeFilipp
Elizabeth R. Moellering

In December 2020, the Supreme Court decided Rutledge v. PCMA and held that an Arkansas drug pricing law was not preempted by ERISA. In the ensuing months, numerous states have upped the ante on PBM legislation and regulation.  More preemption challenges have followed. In this session, Elizabeth Moellering and Kristyn DeFilipp will discuss this phenomenon and the current status of preemption and state PBM laws, including:

  • The legal standard for ERISA preemption and Part D preemption
  • Geographic and substantive trends in PBM legislation post-Rutledge
  • ERISA and Part D litigations about PBM legislation and regulation
  • The likely impact of state PBM laws on plans, beneficiaries and pharmacies
 

9. New Antitrust Compliance Risks Facing Health Plans​
Lisl Dunlop
Kalina M. Tulley

The health care industry is facing increasing antitrust attention from federal and state regulators, as well as private plaintiffs. This session addresses some key areas of potential antitrust risk for health plans and ways to mitigate against them, including:

  • Potential exposure to criminal antitrust prosecutions for anticompetitive agreements, in particular “no poach” agreements and employment-related agreements
  • DOJ guidance for antitrust compliance programs and changes to the DOJ’s corporate leniency policy
  • Risks of state antitrust enforcement and civil litigation for employment-related restraints
  • Changing approaches to anti-steering and anti-tiering provisions, or most-favored nations provisions, in the wake of Sutter and DOJ enforcement actions
  • Potential private antitrust suits in the wake of the repeal of the McCarran-Ferguson exemption for the health insurance industry
 
10:15-10:45 am

Coffee Break, sponsored by Ankura

 
10:45-12:00 noon Extended Sessions

10. Evolution of Value-based Arrangements for Providers and Plans
Matthew Brown
Kate McDonald

  • Innovation in health care has led to the emergence of a variety of novel value-based arrangements
  • Alternative payment structures are being used for traditional clinical care arrangements, as well as administrative, population health management, digital health, and prescription drug arrangements
  • These arrangements give rise to a number of unique regulatory issues, including those involving benefit design, cost-sharing, credentialing, utilization management requirements, delegated services, state insurance regulatory requirements, and medical loss ratio reporting
  • Health plan counsel also need to address unique contracting questions when entering into these arrangements, including what contract form is most appropriate, as well as coding, claim and invoicing consideration
 

11. No Surprises Act: Lessons Learned from the First Year of Implementation
Lisa M. Campbell
Toni Waldman

The No Surprises Act (NSA), which was implemented beginning January 1, 2022, fundamentally reshapes how health plans reimburse out-of-network providers for emergency care and out-of-network providers at an in-network facility. State laws in many states already provided patients some protection from surprise medical billing, and the NSA introduced a complicated new preemption analysis about how these state laws interact with the NSA. Further, the NSA introduces a broad range of additional new health plan obligations, including relating to provider directories, insurance ID card information, and advanced explanation of benefits. This session will provide:

  • The latest federal and state guidance on the implementation of the NSA, with examples of how certain state laws have interacted with NSA
  • Best practices for how to apply the new requirements
  • Insights to help guide implementation of the NSA, and
  • Litigation challenging the independent dispute resolution (IDR) rule, specifically the consideration of the qualifying payment amount by the certified IDR entity
 

12. Health Equity and Nondiscrimination: The Power and Promise of ACA Section 1557
Xavier Baker
David Johnson

  • The Biden Administration and health care industry are focused on health equity and access
  • Current trends toward health equity and the civil rights legal tradition: Does advancing health equity challenge the concepts of equal opportunity, facially neutral, and color-blind law?
  • The current landscape of ACA Section 1557, its implementing regulations, and related case law
  • Related standards for health plan benefit design
  • Language access requirements and best practices
 
12:00-1:00 pm
Lunch on your own
 
1:15-2:15 pm

13. Legal Ethics: Protecting In-House and Outside Counsel
(not repeated)

Kyle Kveton
Karen R. Palmersheim

We’ll discuss the following “hot” topics in legal ethics and address common traps for both in-house and outside counsel:

  • Using and misusing social media–client solicitation and advertising; protecting your online reputation; informal discovery and admissibility of social media posts
  • A long way from the office–the remote practice of law
  • Protecting privileges–watch your emails
  • Handling cybersecurity investigations and identifying conflicts during an investigation
  • Supervising counsel and the ethical rules–the hidden trap
 

5. Transforming the Patient Experience: The Continued Evolution and Integration of Clinical Care and Retail Settings
(repeat)

Melissa Hulke
Jeff Wurzburg

  • The state and federal legal considerations as managed care entities continue to partner with retail health care settings
  • The compliance challenges and best practices for managed care entities seeking further integration with retail health
  • How the COVID-19 pandemic has further aligned managed care and retail health considerations with consumer expectations
  • Case study of how the CVS/Aetna integration of clinical care and retail settings improves access and care coordination while lowering the cost of care
 

9. New Antitrust Compliance Risks Facing Health Plans​
(repeat)

Lisl Dunlop
Kalina M. Tulley

The health care industry is facing increasing antitrust attention from federal and state regulators, as well as private plaintiffs. This session addresses some key areas of potential antitrust risk for health plans and ways to mitigate against them, including:

  • Potential exposure to criminal antitrust prosecutions for anticompetitive agreements, in particular “no poach” agreements and employment-related agreements
  • DOJ guidance for antitrust compliance programs and changes to the DOJ’s corporate leniency policy
  • Risks of state antitrust enforcement and civil litigation for employment-related restraints
  • Changing approaches to anti-steering and anti-tiering provisions, or most-favored nations provisions, in the wake of Sutter and DOJ enforcement actions
  • Potential private antitrust suits in the wake of the repeal of the McCarran-Ferguson exemption for the health insurance industry
 
2:30-3:30 pm

14. COVID-19 Testing: Emergency Rules Compliance, Litigation Risks, and Fraud
(not repeated)

Matthew Donze
Jason Mayer

The presentation will include in-house and outside counsel perspectives on:

  • COVID-19 test coverage requirements under the Families First Coronavirus Relief Act (FFCRA) and the Coronavirus Aid, Relief, and Economic Security (CARES) Act, including new at-home test coverage requirements
  • Compliance issues and considerations for payors regarding federal COVID-19 test coverage requirements
  • Current and anticipated litigation over COVID-19 testing, including new opinions that are likely to shape future litigation
  • Guidance on how payors can identify fraud, waste, and abuse arising from COVID-19 testing
 

6. The Process of Parity: Mental Health Parity and Addiction Act (MHPAEA) Compliance and Enforcement Considerations for the Health Plan
(repeat)

Christina Anderson
Noreen Vergara

The requirements around the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) continue to evolve, and the law continues to gain national attention. Because of its vast reaching scope, MHPAEA is a law that every health plan lawyer should be familiar with. This presentation will offer:

  • The MHPAEA requirements and treatment limitations
  • Recent developments including the Consolidated Appropriations Act of 2021 and the 2022 MHPAEA Report to Congress
  • What may be on the horizon to strengthen MHPAEA‘s regulations and enforcement
 

8. State PBM Laws – When Are They Preempted?
(repeat)
Kristyn Bunce DeFilipp
​Elizabeth R. Moellering

In December 2020, the Supreme Court decided Rutledge v. PCMA and held that an Arkansas drug pricing law was not preempted by ERISA. In the ensuing months, numerous states have upped the ante on PBM legislation and regulation.  More preemption challenges have followed. In this session, Elizabeth Moellering and Kristyn DeFilipp will discuss this phenomenon and the current status of preemption and state PBM laws, including:

  • The legal standard for ERISA preemption and Part D preemption
  • Geographic and substantive trends in PBM legislation post-Rutledge
  • ERISA and Part D litigations about PBM legislation and regulation
  • The likely impact of state PBM laws on plans, beneficiaries and pharmacies
 
3:45-5:00 pm

10. Evolution of Value-based Arrangements for Providers and Plans
(repeat)

Matthew Brown
Kate McDonald

  • Innovation in health care has led to the emergence of a variety of novel value-based arrangements
  • Alternative payment structures are being used for traditional clinical care arrangements, as well as administrative, population health management, digital health, and prescription drug arrangements
  • These arrangements give rise to a number of unique regulatory issues, including those involving benefit design, cost-sharing, credentialing, utilization management requirements, delegated services, state insurance regulatory requirements, and medical loss ratio reporting
  • Health plan counsel also need to address unique contracting questions when entering into these arrangements, including what contract form is most appropriate, as well as coding, claim and invoicing consideration
 

11. No Surprises Act: Lessons Learned from the First Year of Implementation
(repeat)

Lisa M. Campbell
Toni Waldman

The No Surprises Act (NSA), which was implemented beginning January 1, 2022, fundamentally reshapes how health plans reimburse out-of-network providers for emergency care and out-of-network providers at an in-network facility. State laws in many states already provided patients some protection from surprise medical billing, and the NSA introduced a complicated new preemption analysis about how these state laws interact with the NSA. Further, the NSA introduces a broad range of additional new health plan obligations, including relating to provider directories, insurance ID card information, and advanced explanation of benefits. This session will provide:

  • The latest federal and state guidance on the implementation of the NSA, with examples of how certain state laws have interacted with NSA
  • Best practices for how to apply the new requirements
  • Insights to help guide implementation of the NSA, and
  • Litigation challenging the independent dispute resolution (IDR) rule, specifically the consideration of the qualifying payment amount by the certified IDR entity
 

12. Health Equity and Nondiscrimination: The Power and Promise of ACA Section 1557
(repeat)

Xavier Baker
David Johnson

  • The Biden Administration and health care industry are focused on health equity and access
  • Current trends toward health equity and the civil rights legal tradition: Does advancing health equity challenge the concepts of equal opportunity, facially neutral, and color-blind law?
  • The current landscape of ACA Section 1557, its implementing regulations, and related case law
  • Related standards for health plan benefit design
  • Language access requirements and best practices

In-Person Program Format

How It Works

  • We will offer in-depth breakout sessions where speakers and attendees can interact and collaborate with each other in-person.
  • We consider the health and safety of all those onsite at in-person programs our top priority. AHLA will follow guidance and requirements issued by the CDC as well as by state and local government and are working with the hotel to ensure your health and safety as we transition back to in-person programming. 
  • All attendees, who register for the in-person program, will be required to commit to our Duty of Care agreeing to follow the protocols we establish and monitor their own health for the health and safety of all. 
  • To minimize crowding, we are offering extended time for registration. We have adopted a new onsite registration system by providing seamless, touchless check-in, onsite badge printing, and safety supplies to all attendees to use while in attendance.
  • Built-in extended time between sessions for moving from room to room, networking with colleagues, and personal breaktime.  
  • Socially distanced seating arrangements in breakout rooms, regular cleaning in and around meeting spaces, and appropriate signage/floor decals to reinforce spatial distancing and other safety reminders.
  • The program sessions will be recorded. Audio of the presentations, along with the materials will be available for purchase after the program. More information on our ePrograms.

Benefits of the In-Person Program

  • After a year of virtual programming, you will finally be able to step out from behind your computer and network face-to-face with other health law professionals.
  • Interact with colleagues at in-depth breakout sessions.

This program will be formatted as a traditional one and a half day in-person program - we are excited for attendees to connect and network in person.

AHLA is committed to providing a safe and healthy environment for program participants and staff. AHLA has adopted preventative measures to reduce the potential spread of the COVID-19 virus, including proof of vaccine or a negative PCR test, and is following guidance provided by the US Centers for Disease Control and local authorities. Attendees are also expected to do their part and abide by AHLA’s Duty of Care.

Program Accessibility and Special Needs

AHLA is committed to ensuring equitable access to our educational content. We are continually improving the user experience for everyone and offering accessibility accommodations for our in-person programs.

Learn More

Program Accessibility and Special Needs

AHLA is committed to ensuring equitable access to our educational content. We are continually improving the user experience for everyone and offering accessibility accommodations for our in-person programs.

Learn More